Alarm Over Single AIDS Case Is Challenged by Questioners

By MARC SANTORA and LAWRENCE K. ALTMAN; Andrew Pollack in Los Angeles and Carol Pogash in San Francisco contributed reporting for this article.

Published: February 21, 2005

New York City's health commissioner, Thomas R. Frieden, had barely stepped away from the microphone on Feb. 11 after announcing the discovery of a possibly new and deadly H.I.V. strain when the storm started. More than a week later, it has not abated.

One group of scientists not involved in the research was quick to dismiss the news as isolated to one man and unworthy of alarm. Other scientists said not enough research had been done to warrant a public health announcement, and accused Dr. Frieden of excessive haste.

Gay activists worried that Dr. Frieden's use of the announcement to emphasize safe-sex practices would set up gay men as culprits, reviving a concern as old as the disease. Longstanding rivalries among top AIDS researchers resurfaced, and one of the researchers who discovered the possible strain was accused of using a test developed by a company to which he had close ties.

To those who expect government officials to keep diseases at bay, it might seem surprising that a public health announcement about a deadly virus would be attacked, but AIDS is not like tuberculosis or polio. From the moment that H.I.V. was discovered, it caused political chasms and profound disagreements among experts, and in recent weeks the virus seemed to be proving that it could still be treacherous and surprising, both as a deadly disease and a political fuse.

''The old jealousies, rivalries and big egos,'' said Kevin Robert Frost, vice president of the American Foundation for AIDS Research, when asked why the response was so furious. ''Scientists in general react negatively to news by press conference.''

At one level, the reaction illustrates the intense competition among scientists and their institutions to communicate new findings and get credit, crucial in obtaining money to expand their research. Many experts have been involved in the field for years, and in some cases their professional disagreements have developed into the animosities and outright personal hatreds that are common in academia.

Nonetheless, scientists, skeptics by nature and training, have a fundamentally different role than public health officials, who often have to take emergency measures to stop the spread of disease.

As a result, some research scientists said the appearance of a possible drug-resistant and virulent strain of the virus in one 46-year-old man meant little. The man's immune system might have been compromised by the crystal methamphetamine he had taken, they said, or the virus could have rapidly led to full-blown AIDS for other reasons that needed additional investigation before the public was alerted.

''This is a nonstory,'' Dr. Paul Volberding, director of the Center for AIDS Research at the University of California, San Francisco, said in an interview, noting that the pace of change from H.I.V. to AIDS depended not only on the virus but also the patient. ''There have been many cases of rapid progression. The New York case is only that, a case report.''

But public health officials said that with the battle against AIDS possibly on the verge of a new phase, where drug-resistant strains become harder to treat, Dr. Frieden was right to go public. Dr. Alfred Sommer, the dean of the Bloomberg School of Public Health at Johns Hopkins in Baltimore, said health officials often did not have the luxury of waiting for full scientific information before acting.

''For most things we do, we do not have ironclad proof one way or the other,'' he said.

Dr. Frieden said that his initial announcement clearly contained cautions and unknowns, but that his actions were necessary given the potential public health effects.

''We had enough clinical and scientific information to warrant making the announcement because of the immediate implications for the community, and for doctors practicing in New York City,'' he said.

''We run the risk of either being a dollar short and a day late, or shouting fire in a crowded theater,'' said Dr. Michael T. Osterholm, director of for the Center for Infectious Disease Research and Policy at the University of Minnesota. ''The question is,'' he said of Dr. Frieden, ''is he a prophet today or is he a prophet 10 years from now?''

The debate is likely to grow louder beginning tomorrow in Boston when 3,800 of the world's top AIDS experts are to meet in a conference to discuss an array of new scientific findings. Long after the deadline for submissions of reports had passed, the doctors who handled the New York City case, Dr. David D. Ho and Dr. Martin Markowitz, asked for a waiver to discuss the findings about the possible strain they had made at the Aaron Diamond AIDS Research Center in Manhattan. After much wrangling, the organizers of the meeting agreed to hold an unusual special session for the disagreement about the city's announcement.

But scientists were not the only ones upset about the city's actions. Some gay activists asserted that Dr. Frieden was using the possible new strain as a scare tactic to get gay men to practice safe sex, an accusation he denied.